Embolic protection device

ABSTRACT

Disclosed herein are devices and methods for providing embolic protection in a patient&#39;s vascular system. In particular, the devices detailed herein are supported by a flexible scaffold that is coupled to a filter. When deployed into the peripheral or coronary vasculature of a patient, the embolic protection devices of the present disclosure collect and remove embolic debris as a prophylactic measure to lessen the risk of embolic associated complications.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Patent ApplicationSer. No. 62/427,247 “Embolic Protection Devices Having Laser CutFrames,” which was filed on Nov. 29, 2016, the entire contents of whichare hereby incorporated by reference in its entirety.

FIELD OF THE INVENTION

The present disclosure relates generally to apparatuses and methods forproviding embolic protection. In particular, the present disclosurerelates to the collection and removal of emboli in the peripheral andcoronary vasculature of a patient in need thereof.

BACKGROUND OF THE INVENTION

The following description is provided to assist the understanding of thereader. None of the information provided or references cited is admittedto be prior art.

An embolism can be generally defined as a blood vessel obstruction dueto a blood clot or other occlusion that has materialized as a staticdeposit within the peripheral or coronary vasculature of an individual.Embolic particles or debris, such as thrombus, atheroma, and lipids,moreover, are embolism precursors and accordingly the etiological agentsof various medical conditions, including stroke, pulmonary andmyocardial infarction, and kidney failure. See, e.g., Tapson, V. “AcutePulmonary Embolism” N. Engl. J. Med., 358: 1037-52 (2008); see alsoCharles and Epstein, “Diagnosis of Coronary Embolism: a review,” J. R.Soc. Med., 76(10): 863-9 (1983). To this end, embolic prophylaxis orprotection is a clinical model directed at reducing the risk of emboliccomplications associated with various interventional procedures.

With respect to therapeutic vascular procedures, the liberation ofembolic debris, such as, e.g., thrombus, clots, and atheromatous plaque,can obstruct perfusion of downstream vasculature, which may result indeleterious ischemic conditions for a patient. Vascular procedures mostcommonly associated with adverse embolic complications include, forexample, carotid angioplasty and revascularization of degeneratedsaphenous vein grafts. Additionally, percutaneous transluminal coronaryangioplasty, surgical coronary artery bypass grafting, percutaneousrenal artery revascularization, endovascular aortic aneurysm repair,cardiopulmonary bypass, peripheral vascular surgeries,electrophysiological procedures, and catheter-based interventionalcardiology, are similarly associated with complications attributable toembolization.

As a manifest complication of cardiopulmonary procedures, embolic debrisborne out of such surgical interventions impart a substantial risk tothe patient insofar as the potential for surgical dislodgment anddissemination portend the vascular redistribution of such particles,which can be fatal, i.e., when embolizing to the brain or other vitalorgans. Emboli also emanate from ruptured or vulnerable plaque, which istypically the case for cardiogenic emboli, e.g., thrombus, that resultfrom chronic atrial fibrillation in many instances. If not fatal,downstream vascular systems are nonetheless confronted with the damagingimpact of vasculature stasis or ischemia, which can lead to diminishedorgan function and quality of life for the patient. The use of embolicprotection devices to capture and remove embolic detritus, in thisregard, consequently imparts a rubric for improving patient outcomes viacurtailing the incidence of embolic complications at its origin, i.e.,by capturing embolic debris before a downstream occlusion precipitates.

SUMMARY

In one aspect, the present disclosure is directed to an embolicprotection device that entails a conical filter including perforationsfor fluid flow therethrough, and a proximally located ingress, and ascaffold that entails a proximal eyelet having an eyelet axis extendingtherethrough, where the proximal eyelet defines a proximal scaffold end,and an elastomeric frame adapted to operate between expanded andcollapsed profiles, where the frame includes struts extending from theproximal eyelet to define a proximal strut region, and a frame-cellregion having a first edge that is continuous with the proximal strutregion, where the filter is coupled to at least a portion of theframe-cell region to form the embolic protection device. In someembodiments, the embolic protection device further entails an insertableguide extending through the proximal eyelet and the elastomeric frame,where the insertable guide facilitates deployment and directionalpositioning of the device along the eyelet axis.

In illustrative embodiments, the scaffold further comprises a distaleyelet oriented about the eyelet axis and defines a distal scaffold end,and where distal struts extend from the distal scaffold end to define adistal strut region that is continuous with a second edge of theframe-cell region. In some embodiments, the elastomeric frame iscomposed of a material selected from nitinol, stainless steel, titanium,and alloys thereof, and combinations thereof. In certain embodiments,the struts are radially oriented relative to the eyelet axis, and extendfrom the proximal eyelet at an angle ranging from about 10° to about 90°relative to the eyelet axis.

The conical filter has a polymeric material selected from one or morefluoropolymers, polytetrafluoroethylene (PTFE), ePTFE, polyurethane, andpolyethylene, and combinations thereof, in certain embodiments. Inillustrative embodiments, the perforations possess a pore diameter ofabout 5 μm to about 200 μm, while in some embodiments, the filterfurther entails an imperforated section configured to circumferentiallyconform to an interior segment of the frame-cell region. In illustrativeembodiments, the imperforated section is composed of alternatingembrasure segments each separated by an abapical region disposed aboutthe eyelet axis to define a coupling configuration.

In illustrative embodiments, at least one of the abapical regions isoccupied by the imperforated filter material to define an off-setcoupling configuration. The conical filter, moreover, is bonded to theportion of the frame-cell region, in suitable embodiments. In someembodiments, an attachment couples the conical filter to an interiorsegment of the frame-cell region. The distal strut region is taperedtowards the distal eyelet along the eyelet axis, in some embodiments,and has a length of about 1.5 to about 10 times that of either or bothof the proximal strut region and the frame-cell region.

The conical filter is disposed internal to the scaffold and tapersdistally along the eyelet axis, in some embodiments. Likewise, incertain embodiments, the conical filter is disposed internal to thescaffold and tapers distally along the eyelet axis. In some embodiments,the frame-cell region comprises a strut matrix circumferentiallydisposed about the eyelet axis. In illustrative embodiments, thescaffold is radially ridged to maintain blood vessel apposition in adeployed state. In some embodiments, the elastomeric frame comprisesthree integral struts.

In one aspect, the present disclosure provides an embolic protectionsystem that entails a distally tapered filter that includes perforationsfor fluid flow therethrough, and an imperforated section that defines aningress, while an integral scaffold includes a proximal eyelet defininga proximal end of the scaffold, a distal eyelet defining a distal end ofthe scaffold, where both of the eyelets are oriented about alongitudinal eyelet axis, and an elastomeric frame disposed between theproximal and distal eyelets, where the frame has proximal and distalstruts extending from their respective eyelets to respectively defineproximal and distal strut regions, and a frame-cell region disposedbetween, and continuous with, the proximal and distal strut regions,where the imperforated section of the filter is coupled to at least aportion of the frame-cell region, where the filter is disposed internalto the scaffold, and an insertable guide extending through theelastomeric frame and each of the eyelets to facilitate deployment anddirectional positioning of the embolic protection device along theeyelet axis.

In illustrative embodiments, the elastomeric frame is composed of amaterial selected from nitinol, stainless steel, titanium, and alloysthereof, and combinations thereof. In some embodiments, the struts areradially oriented relative to the eyelet axis, and extend from theirrespective eyelets at an angle ranging from about 10° to about 90°relative to the eyelet axis. In illustrative embodiments, the filter iscomposed of a polymeric material selected from one or morefluoropolymers, polytetrafluoroethylene (PTFE), ePTFE, polyurethane, andpolyethylene, and combinations thereof.

The embolic protections systems of the present disclosure, inillustrative embodiments, possess perforations having a pore diameter ofabout 5 μm to about 200 μm. In certain embodiments, the imperforatedsection is composed of alternating embrasure segments each separated byan abapical region disposed about the eyelet axis to define a couplingconfiguration. In suitable embodiments, at least one of the abapicalregions is occupied by the imperforated filter material to define anoff-set coupling configuration. In illustrative embodiments, anattachment couples the imperforated section to the portion of theframe-cell region.

In illustrative embodiments, the distal strut region is tapered towardsthe distal eyelet along the eyelet axis, and has a length of about 1.5to about 10 times that of either or both of the proximal strut regionand the frame-cell region. The frame-cell region entails a strut matrixcircumferentially disposed about the eyelet axis in certain embodiments.In some embodiments, the scaffold is radially ridged to maintain bloodvessel apposition in a deployed state. In illustrative embodiments, theelastomeric frame comprises three integral struts.

In one aspect, the present disclosure entails a method of preventing adisease or condition associated with the presence of an embolism in asubject in need thereof, the method entailing (a) selected a subject,(b) accessing one or more blood vessels of the subject, (c) deploying aninsertable guide, where the insertable guide is unilaterally orbilaterally positioned, (d) deploying an embolic protection device overthe insertable guide, where steps (c) and (d) are performed separately,sequentially or simultaneously, and where the embolic protection deviceincludes (i) a conical filter having perforations for fluid flowtherethrough, and an imperforated section that defines an ingress, (ii)an integral scaffold having a proximal eyelet defining a proximal end ofthe scaffold, and a distal eyelet defining a distal end of the scaffold,and where both of the eyelets are oriented about a longitudinal eyeletaxis.

In accord, the methods further entail (iii) an elastomeric framedisposed between the proximal and distal eyelets, with respect to theembolic protection device employed according to the methods of thepresent invention, where the elastomeric frame has proximal and distalstruts extending from their respective eyelets to respectively defineproximal and distal strut regions, a frame-cell region disposed between,and continuous with, the proximal and distal strut regions, and wherethe imperforated section is coupled to at least a portion of theframe-cell region, (iv) where the insertable guide extends through theelastomeric frame and each of the eyelets along the eyelet axis, (f)capturing embolic debris, and (g) removing the embolic protection devicewith the captured debris from the subject's blood vessel to prevent thedisease or condition associated with the embolism in the subject.

The foregoing summary is illustrative only and is not intended to be inany way limiting. In addition to the illustrative aspects, embodiments,and features described above, further aspects, embodiments, and featureswill become apparent by reference to the following drawings and thedetailed description.

BRIEF DESCRIPTION OF THE FIGURES

FIGS. 1A-1D show isometric views of an illustrative representationconcerning the present invention. FIG. 1A is an isometric view of asingle-eyelet, three-strut frame, scaffold. FIG. 1B is arotational-isometric view of a single-eyelet, three-strut frame,scaffold. FIG. 1C is a longitudinal view of a single-eyelet, three-strutframe, scaffold. FIG. 1D is a perspective-isometric view of asingle-eyelet, three-strut frame scaffold of the present invention.

FIGS. 2A-2C show isometric views of an illustrative representationconcerning the present invention. FIG. 2A is an isometric view of asingle-eyelet, four-strut frame, scaffold.

FIG. 2B is a longitudinal view of a single-eyelet, four-strut frame,scaffold. FIG. 2C is a perspective-isometric view of a single-eyelet,four-strut frame scaffold of the present invention.

FIGS. 3A-3C show perspective-isometric views of an illustrativerepresentation of the present invention. FIG. 3A is a flat-isometricview of a dual eyelet, three-strut frame, scaffold, of the presentinvention. FIG. 3B is a rotated flat-isometric view of a dual eyelet,three-strut frame, scaffold, of the present invention. FIG. 3C shows anorthogonal end-view configuration of the present invention with eyeletsand struts depicted.

FIGS. 4A-4C show perspective-isometric views of an illustrativerepresentation of the present invention. FIG. 4A is a flat-isometricview of a dual eyelet, inverted three-strut frame, scaffold of thepresent invention. FIG. 4B is a rotated flat-isometric view of a dualeyelet, inverted three-strut frame, scaffold, of the present invention.FIG. 4C shows an orthogonal end-view configuration of the presentinvention with eyelets and struts depicted.

FIGS. 5A-5B show perspective-isometric views of an illustrativerepresentation of the present invention. FIG. 5A is aperspective-isometric view of a dual eyelet, four-strut frame, scaffoldof the present invention. FIG. 5B is a longitudinal view of a dualeyelet, four-strut frame, scaffold of the present invention.

FIGS. 6A-6D show perspective-isometric views of an illustrativerepresentation of the present invention. FIG. 6A is aperspective-isometric view of a dual eyelet, inverted six-strut frame,scaffold of the present invention. FIG. 6B is a perspective isometricview of a dual eyelet, inverted proximal six-strut and distal two-strutframe, scaffold of the present invention. FIG. 6C is a rotationalisometric view of a dual eyelet, inverted proximal six-strut and distaltwo-strut frame, scaffold of the present invention. FIG. 6D is alongitudinal view of a dual eyelet, inverted six-strut frame, scaffoldof the present invention.

FIGS. 7A-7D show space-filled isometric views of an illustrativerepresentation of the present invention. FIG. 7A is aperspective-isometric view of a single eyelet, three-strut frame,scaffold with a filter coupled to the distal frame-cell edged of thepresent invention. FIG. 7B is a rotational isometric view of a singleeyelet, three-strut frame, scaffold with a filter coupled to the distalframe-cell edged of the present invention. FIG. 7C is aperspective-isometric view of a single eyelet, three-strut frame,scaffold with a filter coupled to the proximal frame-cell edged of thepresent invention. FIG. 7D is a rotational isometric view of a singleeyelet, three-strut frame, scaffold with a filter coupled to theproximal frame-cell edged of the present invention.

FIGS. 8A-8B show space-filled isometric views of an illustrativerepresentation of the present invention. FIG. 8A is aperspective-isometric view of a dual eyelet, four-strut frame, scaffoldwith a filter coupled to the distal frame-cell edged of the presentinvention. FIG. 8B is a perspective-isometric view of a dual eyelet,four-strut frame, scaffold with a filter coupled to the proximalframe-cell edged of the present invention.

FIG. 9 is a space-filled isometric view showing the embrasures of a dualeyelet, inverted six-strut frame, scaffold with a filter coupled to thedistal frame-cell edged of the present invention.

FIGS. 10A-10D show space-filled isometric views of an illustrativerepresentation of the present invention. FIG. 10A is aperspective-isometric view of a dual eyelet, three-strut frame, scaffoldwith an off-set filter coupled to the frame-cell of the presentinvention. FIG. 10B is a rotational isometric view of a dual eyelet,three-strut frame, scaffold with an off-set filter coupled to theframe-cell of the present invention. FIG. 10C is a perspective-isometricview of an uncoupled off-set filter of the present invention. FIG. 10Dis a rotational isometric view of an uncoupled off-set filter of thepresent invention.

DETAILED DESCRIPTION

In the following detailed description, reference is made to theaccompanying drawings, which form a part thereof. In the drawings,similar symbols typically identify similar components, unless contextdictates otherwise. The illustrative embodiments described in thedetailed description, drawings, and claims are not meant to be limiting.Other embodiments may be utilized, and other changes may be made,without departing from the spirit or scope of subject matter presentedherein. It will be readily understood that the aspects of the presentdisclosure, as generally described herein, and illustrated in thefigures, can be arranged, substituted, combined, separated, and designedin a wide variety of different configurations, all of which areexplicitly contemplated herein.

As used herein, unless otherwise stated, the singular forms “a,” “an,”and “the” include plural reference. Thus, for example, a reference to“an insulator” can include a plurality of insulators.

As used herein, the term “about” will be understood by persons ofordinary skill in the art and will vary to some extent depending uponthe context in which it is used. If there are uses of the term which arenot clear to persons of ordinary skill in the art, given the context inwhich it is used, the term “about” in reference to quantitative valueswill mean up to plus or minus 10% of the enumerated value.

The terms “assessing” and “evaluating” are used interchangeably to referto any form of measurement, and includes determining if an element ispresent or not. The terms “determining,” “measuring,” “assessing,” and“assaying” are used interchangeably and include both quantitative andqualitative determinations. Assessing may be relative or absolute.“Assessing the presence of” includes determining the amount of somethingpresent, as well as determining whether it is present or absent.

As used herein, the terms “biocompatible,” “biocompatible material,”“biocompatible polymer,” or “polymer materials” refer to a synthetic ornatural material that is, for example, non-toxic to biological systemsand/or congruent with biological processes. In this respect,biocompatibility of materials with respect to the present disclosuredenote minimal, negligible, or no risk of immunorejection, injury,damage and/or toxicity to living cells, tissues, organs, and/orbiological systems. In illustrative embodiments, the biocompatiblematerials are one or more polymers or materials selected from, but notlimited to, polyurethane, ETFE, polyacrylates, polyacrylamides,polyacrylamide copolymers, polyacrylic acid, sodium polyacrylate,potassium polyacrylate, lithium polyacrylate, ammonium polyacrylate,ethylene maleic anhydride copolymer, carboxymethylcellulose, polyvinylalcohol copolymers, polyethylene oxide, and copolymers ofpolyacrylonitrile, polylactic acid, polyglycolic acid,poly(lactide-co-glycolide), and/or poly(L-lactide), and the like, andcombinations thereof.

As used herein, the term “composition” refers to a product, material,device or component with specified or particular materials, polymers,compounds, etc., in the specified amounts, as well as any products orthe generation of such products which result, directly or indirectly,from combination of the specified items in the specified amounts.

The terms “coupled,” “connected,” and the like as used herein mean thejoining of two members directly or indirectly to one another. Suchjoining may be stationary (e.g., permanent) or moveable (e.g., removableor releasable). Such joining may be achieved with the two members or thetwo members and any additional intermediate members being integrallyformed as a single unitary body with one another or with the two membersor the two members and any additional intermediate members beingattached to one another. In some embodiments, for example, coupling mayinclude direct or indirect bonding, welding, linking, connecting,adhering, attaching and the like.

As used herein, the terms “cooperatively interact” or “cooperativelyinteracting” refer to the association of two or more adjoiningcomponents, where each component functions to facilitate theassociation. For example, a fitted plug would cooperatively interactwith the component that the plug was fabricated to fit.

As used herein, the term “disease” or “medical condition” are usedinterchangeably and include, but is not limited to, any condition ordisease manifested as one or more physical and/or psychological symptomsfor which treatment and/or prevention is desirable, and includespreviously and newly identified diseases and other disorders. Forexample, a medical condition may be any embolic associated disorder,such as, e.g., stroke, chronic cerebral ischemia, and/or pulmonary ormyocardial infarction.

As used herein, the terms “disengage” or “disengaged configuration”,both refer to act or state of no longer being securely associated orconnected. For example, two components are disengaged with each otherthey are not in physical contact with each other. However, suchcomponents can be in contact while concomitantly occupying a disengagedstate. In this circumstance, the components would not be securelyengaged by such means as, for example, a locking mechanism. If suchcomponents are “reversibly disengaged” then the components are capableof engaging at a different time. The foregoing holds true for anengagement or disengagement with respect to an intravascular procedureemploying devices and components of the present disclosure.

As used herein, the terms “embrasure,” “embrasure segments,” and thelike, refer to regions of the filter that typically circumferentiallyundulate about a frame-cell region of a scaffold to define the filteringress in some embodiments. In addition to providing a seamlesstransition from the scaffold frame-cell region, the embrasures areconfigured as, for example, triangular sections of the imperforatedfilter region to enhance filter coupling and attachment to therespective frame-cell region, while also facilitating capture of embolicdebris by directing or funneling the blood flow influent towards thetapering filter end.

Moreover, embodiments of the present invention entail imperforated,filter ingress, regions configured with alternating apical and abapicalembrasure sections or regions, which may be configured as, but notlimited to, shapes selected from angled, straight, slanted, tapered,curved, diagonal, random, polygonal, rectangular, square, circular,curved, concentric, concave, perimetric, diamond, hexagonal, ortriangular configurations, or any combination thereof.

As used herein, the terms “engage”, “reversible engage”, “reversiblyengaged”, and “engaged configuration” all refer to the act or state ofbeing associated or connected in a secure manner for the purpose ofjoining two or more components for a period of time. For example, twocomponents are engaged with each other when they are in contact andsecurely connected or associated for a period of time. To be in theengaged state, the components are in contact while concomitantlyoccupying an engaged state, such as, for example, a locked state. Ifsuch components are “reversibly engaged” then the components can beengaged and disengaged with respect to the features enabling suchassociation and disassociation, respectively. The foregoing holds truefor an engagement or disengagement with respect to an intravascularprocedure employing devices and components of the present disclosure.

As used herein, the term “encapsulation” or “encapsulating” refers tothe retention of substance within a compartment, delineated by aphysical barrier. For example, the encapsulated components describedherein refer to components which are retained within, and surrounded bya physical barrier.

It should be noted that the term “exemplary” as used herein to describevarious embodiments is intended to indicate that such embodiments arepossible examples, representations, and/or illustrations of possibleembodiments, i.e., where such terms are not intended to connote thatsuch embodiments are necessarily extraordinary or superlative exampleswith respect to the referred to embodiments of the present invention.

As used herein, the term “ischemia reperfusion injury” refers to thedamage caused first by restriction of the blood supply to a tissuefollowed by a sudden resupply of blood and the attendant generation offree radicals. Ischemia is a decrease in the blood supply to the tissueand is followed by reperfusion, a sudden perfusion of oxygen into thedeprived tissue.

As used herein, the term “organ” refers to a part or structure of thebody, which is adapted for a special function or functions, andincludes, but is not limited to, the skin, the lungs, the liver, thekidneys, and the bowel, including the stomach and intestines. Inparticular, it is contemplated that organs which are particularlysusceptible to dysfunction and failure arising from an embolism.“Tissues” are singular or multiply-layered structures, i.e., monolayersor stratified layers of cells, which are organ constituents. One or moredifferent tissues may form an organ or organs. An organ may also becomposed of only one type of tissue or cell, or different tissues orcells.

As used herein, the term “polymer” refers to a macromolecule made ofrepeating monomer or multimer units. Polymers of the present disclosureare polymeric forms of, and include, but are not limited to,polyacrylates, polyacrylamides, polyacrylamide copolymers, polyacrylicacid, sodium polyacrylate, potassium polyacrylate, lithium polyacrylate,ammonium polyacrylate, ethylene maleic anhydride copolymer,carboxymethylcellulose, polyvinyl alcohol copolymers, polyethyleneoxide, and copolymers of polyacrylonitrile, polylactic acid,polyglycolic acid, poly(lactide-co-glycolide), poly(L-lactide),poly(hyaluronic acid), poly(sodium alginate), poly(ethylene glycol),poly(lactic acid) polymers, poly(glycolic acid) polymers,poly(lactide-co-glycolides), poly(urethanes), poly(siloxanes) orsilicones, poly(ethylene), poly(vinyl pyrrolidone), poly(2-hydroxy ethylmethacrylate), poly(N-vinyl pyrrolidone), poly(methyl methacrylate),poly(acrylic acid), poly(vinyl acetate), polyacrylamide,poly(ethylene-co-vinyl acetate), poly(methacrylic acid), polylacticacid, poly(L-lactide) (PLLA), polyglycolic acids, nylons, polyamides,polyanhydrides, poly(ethylene-co-vinyl alcohol, polycaprolactone,polyvinylhydroxide, poly(ethylene oxide), and polyorthoesters or aco-polymer or terpolymer formed from at least two or three members ofthe groups, respectively.

As used herein, “prevention” or “preventing” of an infection orcondition refers to a method or indicator that, in a statistical sample,reduces the occurrence of the infection or condition in a sample patientpopulation relative to an control sample patient population. As usedherein, preventing an infection or condition includes the prevention ofembolic disorders, e.g., stroke, cardiac arrest, etc.

As used herein, the general terms “proximal” and “distal” can be definedwith respect to the location closest to and most distant from a catheterhub. Likewise, the term “proximal” may refer to the scaffold or frameend through which debris enters, via a filter ingress, to be collectedby the associated filter.

As used herein, the term “reticulated material” refers to compositionsor composition matrices composed of network constituents forming one ormore layers or matrix configurations. For example, reticulated materialinclude, but are not limited to, fiberglass, silicone, filter materials(as further detailed herein) one or more polymers, plastic, and resinmaterials, or any combination thereof.

As used herein, the terms “scaffold,” “support,” or “frame,” used in thecontext of a structure that functions as an elastomeric frame withrespect to the embolic protection devices disclosed herein, refer tostructures configured intraluminally operate from collapsed and expandedprofiles, while also possessing radial rigidity as needed. Suchscaffolds have various contemplated compositions, which include, but arenot limited to, nitinol, stainless steel, glass, metals, plastic,silicones, and/or other materials capable of functioning as an embolicprotection device as disclosed herein.

As used herein, the terms “substantial” or “substantially” within thecontext of a “substantially enveloped” surface or region or a“substantially aligned” configuration, refer to, e.g., total or completeenvelopment or alignment, and the like, but also includes lesser thancomplete or total envelopment or alignment, and the like, insofar as theintended purpose for performing the act can be carried out to the sameextent as if the, e.g., envelopment or alignment, were total orcomplete.

As used herein, the terms “treating” or “treatment” or “alleviation”refers to both therapeutic treatment and prophylactic or preventativemeasures, wherein the object is to prevent or slow down (lessen) thetargeted pathologic condition or disorder. A subject is successfully“treated” for a disorder characterized by an embolism if, afterundergoing a procedure pursuant to the devices and methods of thepresent invention, the subject shows observable and/or measurablereduction in or absence of one or more signs and symptoms of aparticular disease or condition associated with embolic disorders.

Overview

Cardiovascular indications, including acute vascular diseases, such asacute coronary syndrome, myocardial infarction, stroke, pulmonaryembolism, deep vein thrombosis, peripheral arterial occlusion and otherblood system thromboses constitute major health risks. Such diseases arecaused by either partial or total occlusion of a blood vessel by a bloodclot or other obstruction, which typically consists of fibrin andaggregated platelets, among other intravascular detritus. See Goldsmith,et al., “Regional cerebral blood flow after omental transposition to theischemic brain in man: A five-year follow-up study.” Acta Neurochir 106:145-152 (1990).

Stroke is a leading cause of long-term disability in the U.S., whilealso accounting for one out of every twenty American deaths annually.See “Heart and Stroke Statistics,” The American Heart Association, 2017.Stroke occurs when a blood vessel that brings oxygen and nutrients tothe brain is either (i) clogged by a blood clot, or some other mass inthe case of an ischemic stroke, or (ii) bursts pursuant to a hemorrhagicstroke. When an ischemic stroke occurs, the blood supply to the brain isinterrupted, and thus brain cells are deprived of glucose and oxygenrequired for proliferation. As a result, brain cells in the affectedregion are damaged, where the extent of such damage typically depends onhow long brain cells are deprived of essential blood nutrients,including oxygen. In the absence of oxygen for only a few minutes, braincell function becomes inevitably lost, which in many cases leads topatient death.

Ischemic stroke is the most common type of stroke accounting for about87% of all strokes. See id. When a thrombus forms and blocks arterialblood flow to the brain, such strokes are clinically defined asthrombotic ischemic strokes. Embolic ischemic strokes, however, refer tothe blockage of an artery by an embolus, a traveling particle or debrismass in the arterial blood stream emanating from the distal vasculature.Emboli most commonly arise from the vascular penumbra of the heart,especially in conjunction with associated atrial fibrillation, butparticularly in a perioperative manner pursuant to an interventionprocedure. Embolizing particles may nevertheless originate from most anybranch of the vascular arterial tree.

Specific treatment of embolic associated disorders, including stroke andvarious other cardiopulmonary or vascular diseases, may includethrombolytic agents, antiplatelet drugs, anticoagulants, and surgery.Such interventions, however, harbor their own risks, where many surgicaltreatments merely recapitulate the embolic cycle by liberating secondaryembolic debris that eventually occlude the downstream vasculature,thereby resulting in continuous procedural complications and poorpatient outcomes. The import of embolic prophylaxis is accordinglymanifest.

Embolic protection devices of the present disclosure are thereforeemployed to capture and remove dislodged debris. These devices aretypified by a matrix or scaffold structure that maintains an operativemeasure of blood vessel patency while apposing the vessel lumen.Coterminous with the embolic device scaffold is a capture or filtercomponent or “basket” that conforms to the vessel wall and maintainsfull-wall apposition during an intervention in illustrative embodiments.Blood flow in this regard is directed into the filter, which typicallypossesses a conical design, thereby effectively capturing debris whilemaintaining perfuse blood flow.

Radiopaque indicators, such as, e.g., gold or tungsten markers, arecoincident with the filter in many embodiments to allow for precisefluoroscopic positioning and verification of apposition prior toproceeding with an intervention. Insertable guides, guidewires, and/orcapture wires function to enhance control and stability of the filterduring the procedure as well. And, while myriad indications areenvisaged for employing such devices, some of the most commonindications include lower extremity procedures, where, together with aguidewire, the embolic devices of the present disclosure are used forstandalone procedures or in concert with percutaneous transluminalangioplasty (PTA) or stenting, i.e., in therapeutic regimens directedtowards the treatment of severely calcified lesions in arteries of thelower extremities. In these applications, the vessel diameter at thefilter basket placement site is from about 2-7 mm in some embodiments.

Likewise, the present devices and methods are indicated with respect tosaphenous vein graft (SVG) procedures, where removal of thrombi andrelated debris is required. The devices also act in conjunction withguidewires in certain embodiments, when percutaneous transluminalcoronary angioplasty or stenting procedures are performed in coronarysaphenous vein bypass grafts with reference vessel diameters in accordwith the foregoing lower extremity procedures. Embolic prophylaxis isalso indicated for carotid procedures involving angioplasty and stentingof the carotid arteries. The diameter of the artery at the site of thefilter basket placement is about from 3-7 mm in some embodiments.

In sum, thrombus, atheroma, lipids, and plaque embolizing to the brain,lungs, or the vasculature penumbra of other vital organs can be a fatalconsequence of cardiopulmonary procedures. Such circulating embolicmaterial arises, in many instances, pursuant to various surgicalprocedures requiring trans-catheter manipulations, among other clinicalinterventions. These unintended consequences of intraluminal medicalprocedures are nevertheless a fundamental risk attendant to suchsurgeries that, in most cases, can be mitigated. Embolic prophylaxis bycapture or collection of antegrade-flowing embolic debris, as detailedpursuant to the present disclosure, substantially improves the overalloutcome and survival of patients that require any of the foregoingcardiopulmonary procedures.

Embolic Devices, Components and Embodiments

Conventional embolic protection devices typically function as anintervening barrier between the source of the clot or plaque and thedownstream vasculature. Issues such as lack of deployed low profile,structural rigidity, and filter integrity, e.g., the ability of thefilter to sustain maximal influent capacity, while maintaining itsporosity and structural conformation, nevertheless plague suchtraditional devices, some of which are described in the following patentpublications, which are hereby incorporated by reference in theirentirety: U.S. Patent Publication Nos. 2004/0215167 and 2003/0100940;and U.S. Pat. Nos. 6,371,935; 6,361,545; 6,254,563; 6,139,517;6,537,297; 6,499,487; 5,769,816; and PCT International PublicationSerial No. WO 2004/019817.

With respect to the foregoing and other conventional embolic protectionpractices in general, each system has its own intrinsic limitations, andprotection afforded by those devices is less than complete in manyinstances. For example, inefficacious embolic protection, in manyinstances, is borne out of oversized device profiles that in fact leadto embolization, i.e., rather than obviating embolism formation.Likewise, incomplete filter apposition or conduit occlusion- andparticularly in bending vessel segments-lack of secondary branchprotection, incomplete aspiration, inadequate filter pore size, devicemediated vessel wall trauma, side branch backwash during occlusionversus siphoning of debris during filtering, and delayed platelet-whitecell embolization from the target site, are all facets of inefficaciousembolic protection. See, e.g., Sangiorgi and Colombo, “EmbolicProtection Devices,” Heart, Vol. 89(9), pp. 990-92 (2003).

In this respect, numerous devices and methods of embolic protection havebeen used adjunctively with percutaneous interventional procedures todate. These techniques, although varied, each falter with respect to oneor more of the following features, i.e., features that are desirable forembolic protection, which include intraluminal delivery, flexibility,trackability, small delivery profile to allow crossing of stenoticlesions, dimensional compatibility with conventional interventionalimplements, ability to minimize flow perturbations, thromboresistance,conformability of the barrier to the entire luminal cross section, and ameans of safely removing the embolic protection device and trappedparticulates. The devices and methods of the present disclosure,however, achieve the foregoing attributes as detailed herein and below.

Currently, there are two general strategies for achieving embolicprotection, (i) techniques that employ occlusion balloons, and (ii)techniques that employ an embolic filter. Balloon occlusion devices,however, may cause distal ischemia that may not be well tolerated bysome patients, while associated aspiration catheters may not retrieveall the particles trapped in the artery. On the other hand, the use ofembolic filters is desirable to the extent that achieving embolicprotection does not inhibit continuous perfusion of blood. And, whilemany conventional filter devices possess a finite lower endparticle-capture size threshold, the present invention embodiments arenot so limited.

In this respect, the present technology relates to, inter alia, novelembolic protection devices and methods that entail a scaffold structurecomposed of struts and at least one eyelet, having an eyelet axis ofradial symmetry extending therethrough, i.e., an eyelet axis. Extendingfrom a distal eyelet, the struts form an elastomeric lattice or frameadapted to operate between an expanded and a collapsed profile insuitable embodiments. Coupled to the elastomeric frame of the scaffold,in suitable embodiments, is a conical or tapered filter having animperforated section for attachment to the frame and a porous sectionpossessing a plurality of perforations, which thereby enables the fluidpassage of blood through the filter. The filter in some embodiments hasa conical shape tapering toward the distal end of the embolic protectiondevice, which opposes a proximally located fluid ingress.

The conical conformation of the present filters imparts a structurepossessing a robust internal embolic capture volume that is markedlyenhanced compared to many conventional devices-depending on particularapplications and procedure indication-which accordingly provides for thecollection of substantially all emboli and related detritus liberatedduring a surgical procedure. For example, depending on a particularindications, e.g., SVG, ceratoid, lower extremity, etc., the filter sizeor lumen apposition diameter ranges from about 0.1, 1, 3, 5, 7, 9, and10 mm to about 0.5, 1, 3, 5, 7, 9, 10, 15, and 20 mm, in someembodiments. In illustrative embodiments, the filter size or lumenapposition diameter ranges from about 3-7 mm.

In accord, such extended filter volumes allow for a greater perforationor pore surface area compared to traditional devices. As such, inconcert with an increased number of filter pores or perforations, thebreadth of the filter area enables the application of various pore sizediameters, i.e., depending upon the requirements associated with anintended medical procedure. Taken together, the foregoing attributespermit a functionally adaptable filter-scaffold structure that confers asurgeon with the ability to specifically select a “personalized” orprocedure-specific device for functional efficacy.

Control over the frequency and dimension of a filter's porosity impartsa system of selectable parameters that function in accord with otherattendant aspects of surgical interventions requiring embolicprotection, such as, e.g., maintaining scaffold adhesion duringdeployment and retrieval, while also decreasing antegrade flow pressure.To this end, minimizing back-flow pressure is a vital aspect of embolicprotection applications that are adapted for use in high-flow vascularor aortic locations—areas in which larger blood volumes and/or pressuresare commonly found—at least insofar as the increased cardiac outputrequired pursuant to such back pressure gradient formation can furtherconfound surgical intervention for patients with heart disease or otherpre-surgical infirmities.

The filters of the present invention relate to compositions andconfigurations concerning one or more of, but not being limited to,conical filter configurations, asymmetric conical or oblique filters,filter ingress configurations, imperforated filters and sectionalregions thereof, filters possessing embrasures, perimeter embrasuresand/or ingress embrasures, offset filter embodiments, filters internalor external to an elastomeric frame, laser perforated filters, filtermeshes, capture membranes, polymeric materials, braided wires, and/ortapered filters, etc. In this respect, such filters are composed of amaterial, in illustrative embodiments, selected from, but not limitedto, polymers, fluoropolymers, polytetrafluoroethylene (PTFE), ePTFE,polyurethane, polyethylene, polypropylene (PP), polyvinylchloride (PVC),polyamide (nylon), polyethylene tetraphlalate, polyether-ether ketone(PEEK), polyether block amide (PEBA), polytetrafluoroethylene (PTFE) andcombinations thereof. Additional or alternative filter materials aredisclosed in, for example, but not limited to, U.S. patent applicationSer. Nos. 08/553,137; 08/580,223; 08/584,759; 08/640,015; 08/645,762;and U.S. patent application Ser. No. 08/842,727, all of which are herebyincorporated by reference in their entirety.

The membrane filters of the present disclosure are alternativelycomposed of a mesh screen entailing several woven or braided wires.These woven or braided wires may be made of any number of suitablebiocompatible materials such as stainless steel, nickel-titanium alloyor platinum. Likewise, some embodiments may include filters composed ofa metals, polymers and/or other constituents that are knitted, woven, ornonwoven fiber filaments and/or wires, in some embodiments. It will beappreciated that various regions, portions, layers, overlappingconfigurations, etc., of the filters of the present invention may beconstructed of an impermeable or imperforated material or section forincreased directional fluidity with respect to the blood influent, asfurther detailed herein and below.

Along the same lines, the filter material may be composed of two or moredifferent materials, each of which can have distinct filter capacityand/or coupling characteristics. The filters of the present disclosuremay possess a uniform or asymmetrical pore distribution and/or pore-sizediameter. Briefly, illustrative embodiments entail filters havingperforations possessing a pore size diameter ranging from about 5 μm toabout 200 μm. The pore diameter of the perforations, in illustrativeembodiments, may also range from about 0.001, 0.01, 0.1, 1, 0.25, 0.5,0.75, 1, 3, 5, 7, 9, 10, 15, 20, 30, 50, 100, 300, or 500 μm to about0.5, 0.75, 1, 3, 5, 7, 9, 10, 15, 20, 30, 50, 100, 500, or 900 μm. Inother embodiments, the pore diameter is from about 0.001, 0.01, 0.1, 1,0.25, 0.5, 0.75, 1, 3, 5, 7, 9, or 10 μm to from about 0.5, 0.75, 1, 3,5, 7, 9, 10, 15, 20, 30, 50, or 100 μm.

The filter perforations, as noted above, are constituted in someembodiments via laser-cutting techniques or are similarly manufacturedthrough the use of stamping, photo-etching, or other cutting techniquesthat provide for and maintain the integrity of the filter, whilefacilitating the collection of embolic debris. In some embodiments, themanufactured filter perforations range in number from about 5 to about5,000. In suitable embodiments, the number of perforations embedded inthe filters of the present invention range from about 1, 250, 500,1,000, 3,000, 5,000, or 10,000 to about 500, 1,000, 5,000, 10,000, or50,000. In suitable embodiments, the laser cut embedded filter possessabout 100-250 perforations. Certain filter embodiments possess aperforated filter area of about 3-8 in², while also having a proximallylocated imperforated section of about 2-5 in², where the imperforatedsection is attached to the scaffold frame as detailed herein.

In the same regard, the filter compositions and materials are formed toa desired filter shape, e.g., conical, asymmetric or oblique, proximallytapered, etc., by first laser-cutting the material to a desiredspecification, and thereafter circumferentially conforming the materialto an interior and/or exterior region of the scaffold frame. The filteris coupled, attached, connected, adhered, bonded, welded, sonic welded,UV treated, and/or extruded, and the like, etc., to the scaffold-framestruts in some embodiments. In a similar fashion, the proximal and/ordistal eyelets may be coupled to the various frame or strut componentsper the heretofore delineated techniques, and those known in the art.

The filters of the present disclosure, moreover, can be coupled to thescaffold-frame, as further discussed below, via a variety of methods asnoted above, which also include, for example, mechanical bonding,solvent or adhesive bonding and/or over-molding in an arrangement suchthat the scaffold frame struts are placed in a topological mold, wherethe polymer material is subsequently incorporated therein to form a bondat the interface between the scaffold frame strut and the polymericfilter material. Additionally or alternatively, the filter can beattached, coupled, affixed, etc., onto or bonded to a scaffold-frame, byany number of suitable attachment means in addition to the foregoing,such as, but not limited to, extrusion, crimping, soldering, bonding,welding, brazing or any combination thereof. With respect to the singleeyelet embodiments detailed below and herein, insofar as the scaffoldframes do not extend into or substantially envelope the filter in suchembodiments, the frame-cell cross-sectional area provides support toreduce the filter crush profile. In addition, the filter material mayalso be bonded to either the outer or inner cell designs of theframe-cell as shown in FIGS. 7A-7D, and as discussed below and herein.

The elastomeric frames of the present invention are adapted to operatebetween expanded and collapsed profiles, as noted above, where the frameincludes struts extending from the proximal eyelet to define a proximalstrut region, and a frame-cell region having a first edge that iscontinuous with the proximal strut region. Various embodiments of thepresent invention also entail a scaffold having a second, distal eyelet,which is similarly oriented about the eyelet axis and thereby defines adistal scaffold end, which will be further detailed herein and below.Distal struts, moreover, accompany embodiment configurations possessinga distal eyelet, where such distal struts extend from the distalscaffold end to define a distal strut region that is continuous with anedge of the frame-cell region.

The frame-cell struts, in some embodiments, are composed of variousmaterials, including, but not limited to, Nitinol, stainless steel,polymer-based compositions, radiopaque materials, e.g., tantalum,platinum, and/or palladium, metals, nickel alloys, shape memory alloymaterials, e.g., NiTi alloys, and/or any other suitable biocompatiblematerials, and combinations thereof. Additionally or alternatively,synthetic polymers are attractive scaffold-matrix materials because theycan be readily manufactured with a wide range of reproducible,biocompatible structures. These scaffold-frame structures can vary incomposition, while still providing sufficient mechanical support forwithstanding compressive, radial and/or tensile forces. In addition tothe materials disclosed above and herein, self-expanding materials mayalso be used, in illustrative embodiments, such as those disclosed inU.S. Pat. Nos. 4,795,458; 5,037,427; 5,089,005; and 5,466,242, thedisclosures of which are hereby incorporated by reference in theirentirety.

Maintaining the shape and integrity of the elastomeric frames of thepresent invention is essential for embolic prophylactic applications ofthe present technology. The elastomeric frames in this respect provideexceptional vessel wall apposition when deployed in an expanded state,while ensuring that the collapsed configuration possess a low profile,which is essential for filter and device control during deployment andretrieval. In some embodiments, a biocompatible nitinol polymercomposite is laser cut to specific parameters prior to filter couplingor attachment. As noted above, the filter is accordingly coupled to atleast a portion of the frame-cell region to form the embolic protectiondevice.

In some embodiments, the imperforated section or region of the filter iscoupled to the interior of the scaffold frame, while in otherembodiments, it is coupled to an exterior region of the scaffold frame.Various other coupling or attachment configurations are within the scopeof the present disclosure, including, but not limited to, coupling thefilter to all or less than all of the scaffold frame struts, either viaan interior or exterior attachment mechanism. In certain embodiments,moreover, one or more filter layers are provided, while some embodimentsprovide for inverted or everted filters. The scaffold frame struts mayalso include a connecting member in some embodiments, such as, e.g., oneor more hooks, loops, seals, rivets, snapping components, screwfixtures, clamps, adhesives, locks, friction fitting components, and thelike, or any combination thereof, to connect or couple to the filter.

The connecting member, to this end, may also be thermally treated toform an engagable component that connects to or with the variouscomponents of the embolic protection devices disclosed herein, such as,e.g., the eyelets, struts, frame-cell regions, and the filter. Likewise,the connecting or attachment member may be directly bonded to the filterin the same manner as the filter is coupled to the frame-cell, i.e., ifno attachment member were present. In some embodiments, the connectingor attachment member, when present, is a helical or looped structurethat encompasses the end of a strut and forms an attachment locus thatconsequently couples to the imperforated filter region.

Such attachment member connections engage and secure the struts againstthe imperforated section of the filter, which accordingly provides for apliable, high-surface area portion, for connection to the filter. Inaddition to the foregoing, the distal edge of the scaffold frame-cellregion can be fixed to the imperforated filter section via a componentor mechanism, such as, for example, a crimped sleeve or other distinctcomponent that facilitates the attachment of the filter to the frame. Inillustrative embodiments, the imperforated section is composed ofalternating embrasure segments disposed about an eyelet axis of radialsymmetry to define a coupling configuration, as further detailed herein.

After forming the substantially resilient, yet compressible,scaffold-frame-filter structure, it may be employed for a particularprocedure, in conjunction with one or more of the following, in certainembodiments, i.e., depending on the intended procedure, an associated orintegral radiopaque marker for fluoroscopic visualization, a hypotubeconnector, flushing needle, one or more guidewires, e.g., primary,capture and retrieval guidewires, associated catheters and/or sheaths,among other components as known in the art for particular procedures.While the present disclosure, in some embodiments, typically does notrequire the use of an inflatable balloon, i.e., due to the resiliency ofthe frame composition, related PTA or other angioplastic applicationsmay require the use of such balloons. Nevertheless, in illustrativeembodiments, a catheter balloon and/or sheath may be employed or omittedas necessary. The scaffold frame is compressed in some embodiments,directly onto the catheter, when used, and a sheath may be positionedover the frame to prevent it from expanding until deployed, in certainembodiments.

Along the same lines, some embodiments of the embolic protection devicesof the present disclosure further include one or more insertable guidesand/or guidewires extending through the proximal eyelet, the hollowvolume formed by the elastomeric frame, and, when applicable, the distaleyelet. The insertable guide facilitates deployment and directionalpositioning of the device along the eyelet axis alone or in conjunctionwith a guide catheter. To this point, the embolic protection devices ofthe present disclosure are typically deployed intravascularly andretrieved upon procedure completion using deployment and retrievalcatheters, which are similarly positioned intravascularly. Suchdeployment and retrieval catheters and other intravascular devices aswill be needed will be familiar to one skilled in this art.

Turning now to the figures, the single eyelet embodiments of the presentinvention are shown by way of example in FIGS. 1-2 and 7. In thisrespect, a three strut scaffold 101, as shown in the three-dimensionalrepresentation of FIG. 1D, is provided. The isometric views pertainingto FIGS. 1A (isometric view) and 1B (rotational side-view), show a strut120 extending from proximal eyelet 110, where struts 120(a), 120(b) and120(c) are orientated about an axis of radial symmetry, i.e., an eyeletaxis, at an approximate 45° angle, which is referred to herein as aprimary strut configuration. Nevertheless, embodiments of the presentinvention include strut angles-relative to the eyelet axis-ranging from1° to 90°.

The individual struts extend from the proximal eyelet 110 to meetframe-cell region 130, which is defined by a lattice network ofintersecting frame-cell struts 150 that terminate at the distal edge ofembodiment 100, as shown in FIGS. 1A and 1B, at 140, which also definesan internal diameter of the scaffold. FIG. 1C shows an orthogonalend-view configuration of embodiment 100 with eyelet 110 and strut 120noted in addition to radius R, which is coincident with the depth of anindividual strut 120 from the radial circumference to the eyelet axis,i.e., half of diameter 140 as noted in FIGS. 1A and 1B.

FIG. 2 shows a similar representative embodiment as illustrated in FIG.1, except these embodiments 200, 201 depict four-strut scaffolds, asshown in the three-dimensional representation 201 of FIG. 2C. Theisometric view pertaining to FIG. 2A shows struts extending fromproximal eyelet 210, where struts 220(a), 220(b) and 220(c) areorientated about an axis of radial symmetry, i.e., an eyelet axis, at anapproximate 45° angle to define a primary strut configuration. Theindividual struts extend from the proximal eyelet 210 meeting frame-cellregion 230, which is defined by a lattice network of intersectingframe-cell struts 250 that terminate at the distal edge of embodiment200, as shown in FIG. 2A at 240, which also defines the internaldiameter of the scaffold. FIG. 2B shows an orthogonal end-viewconfiguration of embodiment 200 with eyelet 210 and strut 220 noted inrelation to radius R, which is coincident with the depth of anindividual strut 220, i.e., half of diameter 240 as noted in FIG. 2A.

The embodiments above concern three and four-strut configurations of thescaffold structures of the present disclosure, yet the devices hereinare not so limited. Any number of struts may be employed in this regardinsofar as sufficient radial rigidity is maintained in concert with alow device profile. As such, some embodiment of the present inventioncontain any number of struts, including proximal and/or distal struts,as further detailed herein, frame-cell strut configurations, latticeregions, attachment components, embrasure attachment components, and thelike, where such components range from about 1, 2, 3, 4, 5, 6, 7, 8, 9,10, 15, 20, 30, 50, or 100, to about 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20,30, 50, 100, or 150 struts or other components noted above. In someembodiments, there are about from 2-8 struts or other components notedabove with respect to the devices and scaffolds of the presentinvention.

Concerning the single eyelet embodiments detailed above and herein,insofar as the scaffold frames do not substantially extend into orcircumferentially surround the filter in such embodiments, theframe-cell cross-sectional area provides for a reduced filter crushprofile. In addition, the filter material may also be bonded to eitherthe outer or inner cell designs of the frame-cell as discussed above andshown in FIGS. 7A-7D.

To this end, the tapered or conical filter is coupled to a distalframe-cell edge, in some embodiments, as shown in FIG. 7, whichhighlights perforations 725 that allow for high volume blood flow whilecapturing embolic debris. Because the elastomeric distal frame-cell edgeis coterminous with the beginning of the filter, i.e., the filteringress, in some embodiments including the single eyelet configurations,in conjunction with expandable resilience of the scaffold frame, it isthe blood flow that in fact expands the entire filter volume upondeployment. The same holds true for the dual eyelet configurationsdetailed below at least insofar as such embodiments entail attachmentand positioning of the filter internal to the scaffold frame.

In other words, certain embodiments of the present device and filterconfigurations do not solely rely on the elastomeric frame or othercomponent of the scaffold matrix to maintain an expanded filter profile.Indeed, the blood flow influent coupled with the internally disposedresilience of the filter function to maintain filter ingress extensionand distention, in illustrative embodiments. One advantage to such adevice-filter configuration is that the integrity of the filter, e.g.,porosity, contiguity, and secure capture profile, is sustained withoutsignificant disruptive constraints acting on the filter, i.e., viacompressive, tensile, and/or radial frame-cell forces, other than bloodflow.

Briefly turning back to FIGS. 1-2, the internal diameter of the scaffoldembodiments are respectively enumerated 140 and 240. This diameter issubstantially coincident with the diameter of the filteringress-depending on the circumference of the ingress with respect toits attachment configuration-internal or external to the frame-cellregion struts. In this regard, FIG. 7 shows representative embodimentsof single eyelet 710 scaffold frames with three struts extendingtherefrom. The scaffolds of the present disclosure, however, can be cutto achieve various structures composed of anything from two totwenty-four or more strut configurations, as noted above, to alter theperformance with respect to the filter and the overall profile of theembolic protection devices disclosed herein. In illustrativeembodiments, the scaffold frames of the present disclosure possess fromabout 2 to about 6 struts.

Again referring to the filter-coupled single eyelet deviceconfigurations, as shown with respect to FIGS. 7A-7D, such taperedfilters 700 entail imperforated filter embrasure sections 715 meetingand extending from a distal edge of frame-cell 730, where the functionalporous section 705 terminates at filter end 711. Open frame-cellsegments 715(a) of frame cell region 730 impart a distally orientedfilter configuration as coupled to the frame. A distally orientedconfiguration in this regard, defines filter embodiments that arecoupled or attached to a distal edge or region of a frame-cell scaffoldsection in a manner as detailed above. This relationship remains truewhether a single or double eyelet configured scaffold is employed.

Specifically concerning FIGS. 7C-7D, tapered filters are shown withimperforated embrasure sections 715 attaching to and extending from aproximal edge or region of frame-cell 730, where the functional poroussection 705 terminates at filter end 711. As described herein, aproximally oriented configuration in this respect, refers to a filterembodiments that are coupled or attached to a proximal edge or region ofa frame-cell scaffold section, which accordingly proximally shifts theentirety of the conical filter towards or within a greater region of theframe-cell. See, e.g., FIGS. 7C-7D. This relationship remains truewhether a single or double eyelet configured scaffold is employed.

In some embodiments, the proximally shifted filter configurationprovides a more ridged support lattice for maintaining confluence andfilter integrity, including the extension of the filter ingress, withrespect to the scaffold frame. Frame-cell region 715(a), with respect toFIGS. 7C-7D, are coterminous with or contain the embrasure segments 715of the imperforated filter region, which imparts a proximally orientedfilter configuration in comparison to the distally orientedconfigurations of the embodiments depicted in FIGS. 7A-7B.

Specifically concerning the embrasure segments, yet irrespective of anyone set orientation of the filter with respect to the frame-cell, i.e.,proximally or distally shifted or positioned, FIGS. 7A-7D denotetriangular embrasures that circumferentially undulate to define thefilter ingress in some embodiments. In addition to providing a seamlesstransition from the scaffold frame-cell region, the embrasures areconfigured as triangular sections of the imperforated filter region toenhance filter coupling and attachment to the respective frame-cellregion, while also facilitating capture of embolic debris by directingor funneling the blood flow influent towards the tapering filter end.Specifically, filters that lack such configurations, i.e., such as aconical filter possessing a substantially uniform perimeter opening, inaddition to having a decreased longitudinal support profile with respectto scaffold-frame attachment, would similarly possess a circumscribedingress perimeter surface area, which consequently marginalizes thefrictional constraints inherent to fluid dynamic systems such as thosefound in intraluminal vasculature systems.

Nevertheless, embodiments of the present invention entail imperforated,filter ingress, regions configured with alternating apical and abapicalembrasure sections or regions, which may be configured as, but notlimited to, shapes selected from angled, straight, slanted, tapered,curved, diagonal, random, polygonal, rectangular, square, circular,curved, concentric, concave, perimetric, diamond, hexagonal, ortriangular configurations, or any combination thereof. In someembodiments, the imperforated, filter ingress, region possesses fromabout 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 30, 50, or 100 alternatingapical or abapical embrasure segments, to about 2, 3, 4, 5, 6, 7, 8, 9,10, 15, 20, 30, 50, 100, or 150 alternating apical or abapical embrasuresegments. See FIGS. 7A-7D. In some embodiments, there are about from 2-8alternating apical or abapical embrasure segments. In some embodiments,moreover, the imperforated-ingress region of the filter lacks one ormore of the alternating apical or abapical embrasure segments, while inother embodiments, one or more of such embrasure segments areadditionally configured to impart an offset filter embodiment as furtherdetailed below and shown pursuant to FIG. 10.

As introduced above, illustrative embodiments of the present disclosureinclude scaffolds entailing a distal eyelet oriented about the eyeletaxis, such that distal struts extend from the distal scaffold end todefine a distal strut region that is continuous with a second or distaledge of the frame-cell region. In short, such dual eyelet configurationsallow for enhanced control and operability of the filter material bothduring deployment and retrieval of the present devices pursuant to aninterventional procedure. In particular, the filters in this respect areattached to an interior frame-cell region in accord with the singleeyelet configurations detailed above, yet the second eyelet in thisregard permits the elastomeric frame to readily lengthen when collapsedduring insertion and retrieval, i.e., when a low profile configurationof the device is needed. Likewise, the additional structural rigidityassociated with dual eyelet configurations are beneficial for proceduresentailing the need for increased luminal apposition.

The dual eyelet embodiments of the present invention are shown by way ofexample in FIGS. 3-6 and 8-9. Briefly, a three-strut dual-eyeletscaffold 300, is depicted per the isometric views pertaining to FIGS. 3Aand 3B (rotational side-view). Strut 320(a), 320(b) and 320(c) extendfrom proximal eyelet 310, where the struts are orientated about an axisof radial symmetry, i.e., an eyelet axis, at an approximate 45° angle inaccord with the primary strut configurations noted above. The individualstruts extend to meet frame-cell region 330, which is defined by alattice network of intersecting frame-cell strut configurations 350 thatare continuous with elongated distal struts, shown by the distal strutregion 370, which extends to, and terminates at, the distal eyelet 380,as shown in FIGS. 3A and 3B. FIG. 3C shows an orthogonal end-viewconfiguration of embodiment 300 with eyelets and struts depicted.

The proximal strut configurations illustrated in FIG. 3 concern aprimary strut or eyelet configuration, where the struts are orientatedabout the eyelet axis at an approximate 45° angle. FIG. 4, however,depicts an inverted strut or eyelet configuration with respect to thesame proximal features. Such a configuration facilitates vessel wallapposition and imparts a maximal frame-cell diameter or circumferenceimmediate to the proximal eyelet to the extent that the invented strutsare orientated about the eyelet axis at an approximate 90° angle. Thesteeper slope of the inverted strut configuration provides forframe-cell induced vessel wall apposition to shift proximally-comparedto the primary strut configuration-which allows for the capture of anincreased volume of embolic particles.

In accord with the foregoing dual-eyelet embodiments of the presentinvention, a three-strut inverted dual-eyelet scaffold 400, is depictedin FIG. 4. The isometric views pertaining to FIGS. 4A and 4B (rotationalside-view), show struts extending from proximal eyelet 410, whereindividual struts 420(a), 420(b) and 420(c) are orientated about theeyelet axis, at an approximate 90° angle in accord with the invertedstrut configuration of the present embodiments. The individual strutsextend to meet frame-cell region 430, which is defined by a latticenetwork of intersecting frame-cell struts 450 that are continuous withelongated distal struts 470 extending to, and terminating at, the distaleyelet 480, as shown in FIGS. 4A and 4B. FIG. 4C shows an orthogonalend-view configuration of embodiment 400 with eyelets and strutsdepicted.

As depicted in FIG. 5A, a four-strut dual-eyelet scaffold 500 is shown,with FIG. 5B representing an orthogonal end-view configuration ofembodiment 500 with eyelets and struts depicted. The isometric viewspertaining to FIG. 5A, which are shown in the absence of an accompanyingfilter, similar to the embodiments above, proximal struts 520 extendfrom proximal eyelet 510, where the proximal struts are orientated aboutan axis of radial symmetry, i.e., an eyelet axis, at an approximate 45°angle. The individual struts extend to meet frame-cell region 530, wherethe distance from proximal eyelet 510 to the initial (proximal) edge ofthe frame-cell is defined by region 560, which is directly proportionalto the foregoing strut angle inasmuch as the more gradual the strutradial slope, i.e., in accord with a lower strut angle, the longer thedistance will be of section 560. Frame-cell region 530 is defined by alattice network of intersecting frame-cell struts that are continuouswith elongated distal struts 570 extending to, and terminating at, thedistal eyelet 580, as shown in FIG. 5A. Individual elongated distalstruts 590(a), 590(b) and 590(c) are enumerated, where the fourth strutcannot be seen insofar as it occupies the same longitudinal plane as590(b), albeit at a distinct three-dimensional Cartesian depth.

As depicted in FIGS. 6A-6D, a proximal six-strut frame region withvarying distal strut configurations 600 is shown, with FIG. 6Drepresenting an orthogonal end-view configuration of embodiment 600having eyelets and struts depicted. The filterless isometric viewspertaining to FIGS. 6A-6C depict proximal struts, extending fromproximal eyelet 610, orientated about an eyelet axis, at an approximate90° angle to define an inverted strut configuration. The six proximalstruts extend to meet frame-cell region 630, where the distance fromproximal eyelet 610 to the initial (proximal) edge of the frame-cell isdefined by region 660, which is directly proportional to the foregoingstrut angle as noted above with respect to FIG. 5. In the inverted strutembodiments, because the proximal struts are configured to rapidly reachtheir maximal frame-cell diameter or circumference, i.e., immediate tothe proximal eyelet, region 660 is relatively shorter compared to region560 of FIG. 5, which shows a more gradual slope pursuant to the primarystrut or eyelet configuration having an approximate 45° angle.

The six-strut frame-cell region 630, moreover, is defined by a latticenetwork of intersecting frame-cell struts that are continuous with sixelongated distal struts, as defined in relation to distal strut region670, which extends to, and terminates at, the distal eyelet 680, asshown in FIG. 6A. FIGS. 6B-C show the same inverted six-strut frame-cellregion 630, as shown with respect to FIG. 6A, albeit with a distinctelongated distal strut region 690, where only two individual elongateddistal struts are shown. In illustrative embodiments, the distal strutregion is tapered towards the distal eyelet along the eyelet axis, andhas a length of about 1.5 to about 10 times that of either or both ofthe proximal strut region and the frame-cell region.

The six proximal-two distal strut configuration, moreover, functions tomaintain a low-profile, low mass scaffold region, while also providingsufficient rigidity for procedures requiring vessel appositionunsuitable for a single eyelet embodiment, yet do not necessitate thestructural capacity of a continuous proximal to distal six-strutconfiguration, in illustrative embodiments. Insofar as the scaffoldframes of the foregoing embodiments extend substantially around thefilter, in addition to the frame-cell cross-sectional area, theelongated distal strut regions, however configured, impart a ridgedsupport structure to reduce the filter crush profile. As before with thesingle eyelet embodiments, the filter material may also be coupledattached, or bonded to either the outer or inner frame-cell latticedesigns as shown in FIGS. 8-10, and as discussed below.

With respect to the dual eyelet embodiments detailed herein, the taperedor conical filter is coupled to the frame-cell edge, as shown in FIG.8A, where the filter has perforations (not enumerated) allowing for highvolume blood flow while capturing embolic debris. The blood flow, inthis respect, enters the filter ingress and expands the filter upondeployment, i.e., inasmuch as the filter is disposed internal to thescaffold. Although externally disposed filter configurations—withrespect to the dual eyelet scaffold frame structures—are within thescope of the present disclosure, and accordingly support or facilitatean expanded filter profile to an extent, the primary function of thedual-eyelet elastomeric frame configurations concerns the maintenance ofstructural rigidity and vessel wall apposition, i.e., any supportingfunction it inures to the filter is ancillary, yet nonetheless notnegligible. The diameter of the frame-cell region, as before, issubstantially coincident with the diameter of the filteringress-depending on the circumference of the ingress with respect toits attachment configuration-internal or external to the frame-cellregion struts.

Referring now to the filter-coupled dual-eyelet device configurations,as shown with respect to FIGS. 8A-8B, such tapered filters 800 entailimperforated filter embrasure sections 815 extending from the attachedframe-cell regions 830, where the remaining porous filter section 805terminates at the distal eyelet 880. Open frame-cell segments 815(a) offrame-cell region 830 are shown with respect to the embodiment of FIG.8A, which imparts a distally oriented coupled filter configuration. Thedistally oriented filter configurations as referred to herein relate tofilters that are coupled or attached to the distal edge or region of aframe-cell scaffold section. As seen in FIG. 8A, the distal end of thefilter abuts, or is adjacent to, the distal eyelet 880.

Concerning FIG. 8B, conical filters are shown with imperforated filterembrasure sections 815 attaching to and extending from the proximal edgeof frame-cell 830, where the remaining porous filter section 805terminates at a distance 835 from the distal eyelet 880. Such aproximally oriented filter configuration refers to a filter of thepresent disclosure that is coupled to the proximal edge or region of aframe-cell scaffold section, which accordingly shifts the entirety ofthe conical filter towards or within a greater region of the frame-cell,while accordingly generating distance 835. Proximally shifted filterembodiments are advantageous insofar as such configurations allow forthe filter to conform in the vasculature in relation to blood volume,i.e., as opposed to statically maintaining a direct conformalrelationship with the frame alone as it expands and retracts in concertwith the elastomeric frame. This allows the device and filter to betterconform to the patient's vessel and attendant blood flow, whichconsequently reduces any unwanted stress that results in undesirablefunctionality of the device.

When in an expanded configuration, in suitable embodiments in thisrespect, the filter has a generally conical shape with the imperforatedend portion, i.e., the ingress region. This ingress region has asubstantially constant diametric profile that is structurally maintainedthrough the frame-cell attachment, yet remains distally flexible withrespect to a conformation adapting to the fluid dynamics pertaining toany particular volume or pressure of the influent blood source.Alternatively, in some embodiments, a reduced ingress profile ismaintained. Here, after commencing deployment, the ingress end portionexpands and generally follows the shape of the frame-cell region afterthe device filter has captured particles during a procedure.Subsequently, after the user begins retracting the filter, it cinches orcloses around the proximal portion of any particles caught within thefilter prior to any substantial reduction in diameter of the remaining,distal portions of the filter. In other words, the proximal end of thefilter at least partially closes first, preventing the distal end of thefilter from expelling captured embolic debris.

The foregoing relationships are facets of the filter configuration,i.e., whether it is proximally or distally shifted as shown in FIGS.8A-8B, which may depend upon the particular needs for a particularprocedure, e.g., whether a more ridged support lattice for maintainingthe confluence of the filter and integrity of the filter ingress isrequired. Frame-cell region 815(a), with respect to FIG. 8B, contain oroverlap the embrasure segments 815 of the imperforated filter region,which imparts a proximally oriented filter configuration in comparisonto the distally oriented configurations of the FIGS. 8A-8B embodiments.

FIG. 9 shows a filter distally-coupled to an inverted six-strutdual-eyelet device embodiment 900. Briefly, the isometric view depictssix proximal struts, extending from proximal eyelet 910, orientatedabout an eyelet axis at an approximate 90° to define an inverted strutconfiguration. The six proximal struts extend to meet frame-cell region930, where the distance from proximal eyelet 910 to the initial(proximal) edge of the frame-cell is defined by region 960, which isdirectly proportional to the foregoing strut angle. In these invertedstrut embodiments, the proximal struts are configured to rapidly reachtheir maximal frame-cell diameter or circumference, i.e., immediate tothe proximal eyelet.

Such tapered filters entail imperforated filter embrasure sections 915extending from the attached frame-cell regions 930, where the remainingporous filter section 905 terminate at the distal eyelet 980. Openframe-cell segments 916 of frame-cell region 930 are shown with respectto the embodiment of FIG. 9, which imparts a distally oriented coupledfilter configuration. The distally oriented filter configurations asreferred to herein relate to filters that are coupled or attached to thedistal edge or region of a frame-cell scaffold section. As seen in FIG.9, the distal end of the filter abuts, or is adjacent to, the distaleyelet 980.

To the extent that the collapsing of embolic protection devices andtheir attendant filters has remained a pressing issue in the practice ofpercutaneous coronary and peripheral interventions, profile reduction isa key attribute of the present devices and filter delivery systems. SeeSangiorgi and Colombo, “Embolic Protection Devices,” Heart, Vol. 89(9),pp. 990-92 (2003). Certain filter materials in conjunction with theirtraditional deployment devices may fold and/or bunch, which accordinglyincreases the cross-sectional area as it enters the delivery system. Seeid. As such, the present devices and filters function to reduce anyinitial filter material entanglement in this regard by offsetting thefilter with respect to the where and how much of the filter is coupledto the frame-cell.

In this way, by positioning the filter material in non-uniformconfigurations at various locations about the frame-cell, it is possibleto obviate such initial congestion of the filter material upondeployment into the delivery system. Such configurations, moreover, aredesigned to collect and hold embolic debris away from the vesselcenterline. In this case, an asymmetric cone shaped filter is attachedto the elastomeric frame, where the collected emboli will accordinglyaccumulate at the distal end of the conical filter and are held offsetin the vessel, thus allowing relatively unperturbed flow at the vesselcenterline.

As noted above with respect to the embrasure segments, and concerningthe set orientation of the filter with respect to the frame-cell, i.e.,proximally or distally positioned, the embrasures circumferentiallyundulate about the frame-cell to define the filter ingress in a uniformconfiguration, i.e., that is not offset. See FIGS. 7A-7D. In addition toproviding a seamless transition from the scaffold frame-cell region, theembrasures are configured as triangular sections of the imperforatedfilter region to enhance the capture of embolic debris as noted above.In this regard, as shown in FIG. 10, the filter embrasure segments areincompletely connected or attached to both the proximal and distalframe-cell regions in an offset configuration.

These offset filter configurations possess a general, three-dimensional,configuration of an asymmetric or oblique cone having a shape similar tothat of a waffle cone, in some embodiments, which can be most clearlyseen with respect to FIGS. 10C-10D. First referring to FIGS. 10A-10B,however, a three-strut, dual-eyelet, scaffold is depicted, where theconical filter is coupled to and disposed internally with respect to theelastomeric frame. Similar to above, the filter is composed of aperforated region distal to the frame-cell, while the imperforatedsection constitutes the offset portion of the filter that is coupled orattached to the scaffold.

The OS section of FIG. 10A and FIG. 10B (rotational side-view) is anopen section of the proximal frame-cell region that is devoid ofaccompanying filter material. Nevertheless, the distal frame-cell regionimmediate thereto shows attached or coupled filter material. Concerningthe same illustrations, the OS' section relates to the proximalframe-cell region diametrically opposed to OS, where the OS'imperforated filter embrasure segments are internally attached to boththe offset proximal frame-cell region and the distal frame-cell region.FIGS. 10C-10D show the filter embodiment OS and OS' regions with thescaffold frame removed for clarity. Again, these offset filterconfigurations possess a general, three-dimensional, configuration of anasymmetric or oblique cone having a shape similar to that of a wafflecone, in some embodiments, which can be most clearly seen with respectto FIGS. 10C-10D.

In short, the embolic protection devices of the present disclosureentail a distally tapered filter that includes perforations for fluidflow therethrough, and an imperforated section that defines an ingressin some embodiments, while an integral scaffold includes a proximaleyelet defining a proximal end of the scaffold. A distal eyelet defininga distal end of the scaffold is provided in suitable embodiments, whereboth of the eyelets are oriented about a longitudinal eyelet axis, andan elastomeric frame disposed between the proximal and distal eyelets,where the frame has proximal and distal struts extending from theirrespective eyelets to respectively define proximal and distal strutregions, and a frame-cell region disposed between, and continuous with,the proximal and distal strut regions, where the imperforated section ofthe filter is coupled to at least a portion of the frame-cell region,where the filter is disposed internal to the scaffold, and an insertableguide extending through the elastomeric frame and each of the eyelets tofacilitate deployment and directional positioning of the embolicprotection device along the eyelet axis.

Methods and Applications

In one aspect, the present disclosure entails a method of preventing adisease or condition associated with the presence of an embolism in asubject in need thereof, the method entailing (a) selected a subject,(b) accessing one or more blood vessels of the subject, (c) deploying aninsertable guide, where the insertable guide is unilaterally orbilaterally positioned, (d) deploying an embolic protection device overthe insertable guide, where steps (c) and (d) are performed separately,sequentially or simultaneously, and where the embolic protection deviceincludes (i) a conical filter having perforations for fluid flowtherethrough, and an imperforated section that defines an ingress, (ii)an integral scaffold having a proximal eyelet defining a proximal end ofthe scaffold, and a distal eyelet defining a distal end of the scaffold,and where both of the eyelets are oriented about a longitudinal eyeletaxis.

In accord, the methods further entail (iii) an elastomeric framedisposed between the proximal and distal eyelets, with respect to theembolic protection device employed according to the methods of thepresent invention, where the elastomeric frame has proximal and distalstruts extending from their respective eyelets to respectively defineproximal and distal strut regions, a frame-cell region disposed between,and continuous with, the proximal and distal strut regions, and wherethe imperforated section is coupled to at least a portion of theframe-cell region, (iv) where the insertable guide extends through theelastomeric frame and each of the eyelets along the eyelet axis, (f)capturing embolic debris, and (g) removing the embolic protection devicewith the captured debris from the subject's blood vessel to prevent thedisease or condition associated with the embolism in the subject.

FIGS. 1-10, as discussed above, show various embodiments for the embolicprotection device that each have an expanded configuration for trappingembolic particles and a contracted configuration which it adopts whenbeing delivered through a delivery device, such as, but not limited to acatheter, micro-catheter or hypotube. The insertable guide in thisregard extends through the one or more eyelet configurations and areconnected to an expandable porous filter at one or more proximalregions, i.e., about the frame-cell region. In some embodiments, a0.014-0.016 inch guidewire is provided with a polyurethane filtermounted at the distal end. The methods and systems of the presentinvention require, in some embodiments, both a delivery and a retrievalcatheter. The filter, moreover, contains a pre-shaped nitinol expansionsystem that facilitates fluoroscopic visualization, accurate deployment,and vessel wall apposition.

The filter guidewire is placed within the delivery catheter and ispassed through the target lesion, and the delivery catheter issubsequently withdrawn. Thereafter, the filter is deployed and crossesan intended lesion to reach a site approximately 3-10 cm distal thereto,the filter is expanded and routine angioplasty or other procedure isperformed in some embodiments. As the blood passes through the filter,emboli are captured in the filter. At the end of the procedure, thefilter is collapsed, trapping embolic debris, which are retrieved byretracting the wire into a retrieving catheter, in some embodiments. Atthis point, the entire device and its embolic contents are retracted. Itwill be readily apparent to those skilled in the art that variousiterations of the foregoing methods, which may include additional oralternative clinical tools, are envisaged with respect to the needs ofany specific procedure.

The present disclosure is not to be limited in terms of the particularembodiments described in this application. Many modifications andvariations can be made without departing from its spirit and scope, aswill be apparent to those skilled in the art. Functionally equivalentmethods and apparatuses within the scope of the disclosure, in additionto those enumerated herein, will be apparent to those skilled in the artfrom the foregoing descriptions. Such modifications and variations areintended to fall within the scope of the appended claims. The presentdisclosure is to be limited only by the terms of the appended claims,along with the full scope of equivalents to which such claims areentitled. It is to be understood that this disclosure is not limited toparticular methods, reagents, compounds compositions or biologicalsystems, which can, of course, vary. It is also to be understood thatthe terminology used herein is for the purpose of describing particularembodiments only, and is not intended to be limiting.

In addition, where features or aspects of the disclosure are describedin terms of Markush groups, those skilled in the art will recognize thatthe disclosure is also thereby described in terms of any individualmember or subgroup of members of the Markush group.

As will be understood by one skilled in the art, for any and allpurposes, particularly in terms of providing a written description, allranges disclosed herein also encompass any and all possible subrangesand combinations of subranges thereof. Any listed range can be easilyrecognized as sufficiently describing and enabling the same range beingbroken down into at least equal halves, thirds, quarters, fifths,tenths, etc. As a non-limiting example, each range discussed herein canbe readily broken down into a lower third, middle third and upper third,etc. As will also be understood by one skilled in the art all languagesuch as “up to,” “at least,” “greater than,” “less than,” and the likeinclude the number recited and refer to ranges which can be subsequentlybroken down into subranges as discussed above. Finally, as will beunderstood by one skilled in the art, a range includes each individualmember. Thus, for example, a group having 1-3 struts refers to groupshaving 1, 2, or 3 struts. Similarly, a group having 1-5 struts refers togroups having 1, 2, 3, 4, or 5 struts, and so forth.

While various aspects and embodiments have been disclosed herein, otheraspects and embodiments will be apparent to those skilled in the art.The various aspects and embodiments disclosed herein are for purposes ofillustration and are not intended to be limiting, with the true scopeand spirit being indicated by the following claims.

All references cited herein are incorporated by reference herein intheir entireties and for all purposes to the same extent as if eachindividual publication, patent, or patent application was specificallyand individually incorporated by reference in its entirety for allpurposes.

What is claimed is:
 1. An embolic protection device, comprising: (a) aconical filter comprising perforations for fluid flow therethrough, anda proximally located ingress; and (b) a scaffold, comprising: (i) aproximal eyelet having an eyelet axis extending therethrough, whereinthe proximal eyelet defines a proximal scaffold end; and (ii) anelastomeric frame adapted to operate between expanded and collapsedprofiles, wherein the frame comprises: (I) struts extending from theproximal eyelet to define a proximal strut region; and (II) a frame-cellregion having a first edge that is continuous with the proximal strutregion, wherein the filter is coupled to at least a portion of theframe-cell region to form the embolic protection device.
 2. The embolicprotection device of claim 1, wherein the scaffold further comprises adistal eyelet oriented about the eyelet axis and defines a distalscaffold end, and wherein distal struts extend from the distal scaffoldend to define a distal strut region that is continuous with a secondedge of the frame-cell region.
 3. The embolic protection device of claim1, wherein the elastomeric frame is composed of a material selected fromthe group consisting of nitinol, stainless steel, titanium, and alloysthereof, and combinations thereof.
 4. The embolic protection device ofclaim 1, wherein the struts are radially oriented relative to the eyeletaxis, and extend from the proximal eyelet at an angle ranging from about10° to about 90° relative to the eyelet axis.
 5. The embolic protectiondevice of claim 1, wherein the conical filter comprises a polymericmaterial selected from the group consisting of one or morefluoropolymers, polytetrafluoroethylene (PTFE), ePTFE, polyurethane, andpolyethylene, and combinations thereof.
 6. The embolic protection deviceof claim 1, wherein the perforations possess a pore diameter of about 5μm to about 200 μm.
 7. The embolic protection device of claim 1, whereinthe conical filter further comprises an imperforated section configuredto circumferentially conform to an interior segment of the frame-cellregion.
 8. The embolic protection device of claim 7, wherein theimperforated section is composed of alternating embrasure segments eachseparated by an abapical region disposed about the eyelet axis to definea coupling configuration.
 9. The embolic protection device of claim 8,wherein at least one of the abapical regions is occupied by theimperforated filter material to define an off-set couplingconfiguration.
 10. The embolic protection device of claim 1, wherein theconical filter is bonded to the portion of the frame-cell region. 11.The embolic protection device of claim 1, wherein an attachment couplesthe conical filter to an interior segment of the frame-cell region. 12.The embolic protection device of claim 2, wherein the distal strutregion is tapered towards the distal eyelet along the eyelet axis, andhas a length of about 1.5 to about 10 times that of either or both ofthe proximal strut region and the frame-cell region.
 13. The embolicprotection device of claim 1, wherein the conical filter is disposedinternal to the scaffold and tapers distally along the eyelet axis. 14.The embolic protection device of claim 2, wherein the conical filter isdisposed internal to the scaffold and tapers distally along the eyeletaxis.
 15. The embolic protection device of claim 1, wherein theframe-cell region comprises a strut matrix circumferentially disposedabout the eyelet axis.
 16. The embolic protection device of claim 1,wherein the scaffold is radially ridged to maintain blood vesselapposition in a deployed state.
 17. The embolic protection device ofclaim 2, wherein the elastomeric frame comprises three integral struts.18. An embolic protection system, comprising: (a) a distally taperedfilter, comprising: (i) perforations for fluid flow therethrough; and(ii) an imperforated section that defines an ingress; (b) an integralscaffold, comprising: (i) a proximal eyelet defining a proximal end ofthe scaffold; (ii) a distal eyelet defining a distal end of thescaffold, wherein both of the eyelets are oriented about a longitudinaleyelet axis; and (iii) an elastomeric frame disposed between theproximal and distal eyelets, the frame comprising: (I) proximal anddistal struts extending from their respective eyelets to respectivelydefine proximal and distal strut regions; and (II) a frame-cell regiondisposed between, and continuous with, the proximal and distal strutregions, wherein the imperforated section of the filter is coupled to atleast a portion of the frame-cell region, and wherein the filter isdisposed internal to the scaffold; and (c) an insertable guide extendingthrough the elastomeric frame and each of the eyelets to facilitatedeployment and directional positioning of the embolic protection devicealong the eyelet axis.
 19. The embolic protection system of claim 18,wherein the elastomeric frame is composed of a material selected fromthe group consisting of nitinol, stainless steel, titanium, and alloysthereof, and combinations thereof.
 20. The embolic protection system ofclaim 18, wherein the struts are radially oriented relative to theeyelet axis, and extend from their respective eyelets at an angleranging from about 10° to about 90° relative to the eyelet axis.
 21. Theembolic protection system of claim 18, wherein the filter is composed ofa polymeric material selected from the group consisting of one or morefluoropolymers, ePTFE, polytetrafluoroethylene (PTFE), polyurethane, andpolyethylene, and combinations thereof.
 22. The embolic protectionsystem of claim 18, wherein the perforations possess a pore diameter ofabout 5 μm to about 200 μm.
 23. The embolic protection system of claim18, wherein the imperforated section is composed of alternatingembrasure segments each separated by an abapical region disposed aboutthe eyelet axis to define a coupling configuration
 24. The embolicprotection system of claim 23, wherein at least one of the abapicalregions is occupied by the imperforated filter material to define anoff-set coupling configuration.
 25. The embolic protection system ofclaim 18, wherein an attachment couples the imperforated section to theportion of the frame-cell region.
 26. The embolic protection system ofclaim 18, wherein the distal strut region is tapered towards the distaleyelet along the eyelet axis, and has a length of about 1.5 to about 10times that of either or both of the proximal strut region and theframe-cell region.
 27. The embolic protection system of claim 18,wherein the frame-cell region comprises a strut matrix circumferentiallydisposed about the eyelet axis.
 28. The embolic protection system ofclaim 18, wherein the scaffold is radially ridged to maintain bloodvessel apposition in a deployed state.
 29. The embolic protection systemof claim 18, wherein the elastomeric frame comprises three integralstruts.
 30. An method of preventing a disease or condition associatedwith the presence of an embolism in a subject in need thereof, themethod comprising: (a) selected a subject; (b) accessing one or moreblood vessels of the subject; (c) deploying an insertable guide, whereinthe insertable guide is unilaterally or bilaterally positioned; (d)deploying an embolic protection device over the insertable guide,wherein steps (c) and (d) are performed separately, sequentially orsimultaneously, (e) wherein the embolic protection device comprises: (i)a conical filter having perforations for fluid flow therethrough, and animperforated section that defines an ingress; (ii) an integral scaffoldhaving a proximal eyelet defining a proximal end of the scaffold, and adistal eyelet defining a distal end of the scaffold, wherein both of theeyelets are oriented about a longitudinal eyelet axis; and (iii) anelastomeric frame disposed between the proximal and distal eyelets,wherein the elastomeric frame comprises proximal and distal strutsextending from their respective eyelets to respectively define proximaland distal strut regions, a frame-cell region disposed between, andcontinuous with, the proximal and distal strut regions, and wherein theimperforated section is coupled to at least a portion of the frame-cellregion, (iv) wherein the insertable guide extends through theelastomeric frame and each of the eyelets along the eyelet axis; (f)capturing embolic debris; and (g) removing the embolic protection devicewith the captured debris from the subject's blood vessel to prevent thedisease or condition associated with the embolism in the subject.